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Understanding managed care risk sharing arrangements.

J R Leigh1

  • 1Wyatt Company, New York, USA.

Benefits Quarterly
|December 9, 1994
PubMed
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Employers can use risk-sharing agreements with managed care organizations to ensure plan success or reduce failure risks. These agreements involve financial risk mitigation for unfavorable claims experiences, benefiting both parties.

Area of Science:

  • Health economics
  • Managed care
  • Healthcare management

Background:

  • Managed care organizations (MCOs) partner with employers to offer health plans.
  • Employers face financial risks associated with employee healthcare claims.
  • Ensuring the success of managed care plans is crucial for employers.

Purpose of the Study:

  • To explore the utility of risk-sharing agreements (RSAs) between MCOs and employers.
  • To determine how RSAs can guarantee short-term managed care plan success.
  • To investigate how RSAs can mitigate managed care plan failure.

Main Methods:

  • Analysis of contractual frameworks in employer-sponsored healthcare.
  • Examination of financial risk-sharing mechanisms in MCO-employer partnerships.

Related Experiment Videos

  • Case study review of implemented risk-sharing agreements.

    • Main Results:

    • Risk-sharing agreements enable employers to secure managed care plan performance.
    • MCOs financially share the employer's risk of adverse claims experience.
    • RSAs provide a mechanism for mitigating financial downside for employers.

    Conclusions:

    • Risk-sharing agreements are a viable financial tool for employers in managed care.
    • These agreements align incentives between MCOs and employers.
    • RSAs can enhance the stability and predictability of managed care plan outcomes.